Job Details

Job Description:

A leading organization is seeking a dedicated Medical Director to oversee clinical review processes and ensure the delivery of high-quality medical management. This remote position involves engaging in medical policy reviews, participating in multidisciplinary team activities and providing expert guidance on complex cases. The ideal candidate will bring strong clinical expertise, excellent communication skills and experience in medical management within the health insurance industry.

Responsibilities:

• Conduct electronic review of escalated cases against medical policy criteria, including telephonic peer-to-peer discussions to determine medical necessity and appropriateness.
• Complete initial case determinations, review appeals and grievances, and perform other assigned reviews.
• Compose clear and concise rationales for member and provider determination notifications while complying with all relevant standards and regulations.
• Ensure all aspects of the medical management process align with community standards of care.
• Participate actively as a member of the multidisciplinary team, attending huddles and grand rounds.
• Advise the team on cases requiring physician expertise and participate in protocol and guideline development to maintain review consistency.
• Lead and manage projects or contribute as a subject matter expert on project teams focused on clinical initiatives.

Requirements:

• Active, unrestricted medical state licensure required for Pennsylvania, New York, or West Virginia
• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
• 5+ years in clinical, direct patient care in hospital, outpatient or private practice settings
• 1+ year in medical management within a health insurance plan
• Strong knowledge of managed care industry standards and practices
• Board certification in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association
• Excellent critical thinking, case management and communication skills.
• Ability to collaborate effectively with multidisciplinary teams
• Proficiency in clinical software applications

Pay Range:
The anticipated pay range for this position is $140.00 - $145.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity.
We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.